Efecto de la higiene diaria con clorhexidina sobre la incidencia de contaminaciones de hemocultivos en el paciente crítico

• Autores: P. Garrido Benedicto, P. Cueto Quintana, E. Farré Temens, Montserrat Mariné i Cabré, J. Riba Reig, Ramón Molina Chueca
• Localización: Enfermería intensiva, ISSN 1130-2399, Vol. 28, Nº. 3, 2017, págs. 97-104
• Idioma: español
• DOI: 10.1016/j.enfi.2016.10.004
• Títulos paralelos:
  • Effect of daily cleaning with chlorhexidine on the incidence of contamination of blood cultures in the critical patient
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• Resumen
  • español

    Objetivo Evaluar la eficacia de la higiene diaria con esponjas impregnadas con clorhexidina al 4% para disminuir la contaminación de hemocultivos en pacientes ingresados en UCI.

    Material y método Estudio prospectivo, cuasi experimental, longitudinal, unicéntrico. Durante 24 meses (de abril de 2013 a marzo de 2015) fueron analizados 237 pacientes que cumplieron los criterios de inclusión, y fueron divididos en 2grupos: uno recibió higiene corporal diaria con jabón común (grupo control, n= 118) y el otro con clorhexidina (grupo intervención, n= 119). Fueron incluidas variables demográficas, tipo de enfermedad, nivel de gravedad, estancia y mortalidad en UCI y hospitalaria, y tiempo trascurrido (minutos) desde el baño hasta la extracción de los hemocultivos.

    Resultados El análisis estadístico mostró una mayor proporción de contaminación de los hemocultivos durante el período control con respecto al de intervención (15,5 vs. 6,3%); con una diferencia significativa: 9,23% (IC 95%: 1,34-16,7%), odds ratio de 2,73 (IC 95%: 1,13-6,63). El análisis de supervivencia mostró una menor probabilidad de contaminación de los hemocultivos hasta las 18 h desde el baño. El baño sin clorhexidina aumentó el riesgo de contaminación de los hemocultivos (HR: 3,05; IC 95%: 1,14-8,12).

    Conclusiones El empleo de jabón con clorhexidina al 4% en la higiene diaria de los pacientes críticos disminuyó la incidencia de contaminaciones de hemocultivos y su efecto perduró al menos 18 h.

  • English

    Objective To evaluate the efficacy of daily cleaning with 4% chlorhexidine-impregnated sponges in decreasing contamination of blood cultures in critically-ill patients.

    Material and methods Prospective, quasi-experimental, longitudinal, single-centre trial. During 24 months (April 2013 to March 2015), we analysed 237 patients who fulfilled the inclusion criteria, divided into 2groups: one underwent daily cleaning with common soap (control group, n= 108), and the other with chlorhexidine (intervention group, n= 109). Demographic variables, pathology group, severity scores, ICU and hospital length of stay and mortality, and time passed since cleaning to blood culture extraction were included.

    Results Statistical analysis showed a higher proportion of contaminated blood cultures during the control group period in contrast with the intervention group period (15 vs. 6.3%), with a significant difference: 9.23% (CI95%: 1,34-16,7%), with an odds ratio of 2,73 (CI95%: 1,13-6,63). Surveillance analysis showed lower probability of blood culture contamination within the 18hours following daily cleaning. Cleaning without chlorhexidine increased contamination of blood cultures (HR: 3,05; CI95%: 1,14-8,12).

    Conclusions The use of 4% chlorhexidine-impregnated sponges for daily cleaning of critically-ill patients decreases blood culture contamination incidence and its protection lasts for almost 18h.

• Referencias bibliográficas
  • [1] A. Qamruddin, N. Khanna, D. Orr. Peripheral blood culture contamination in adults and venepuncture technique: Prospective cohort study....
  • [2] D.W. Bates, L. Goldman, T.H. Lee. Contaminant blood cultures and resource utilization. The true consequences of false-positive results....
  • [3] Y.F. Van der Heijden, G. Miller, P.W. Wright, B.E. Shepherd, T.L. Daniels, T.R. Talbot. Clinical impact of blood cultures contaminated...
  • [4] C.E. Edmiston Jr., G.R. Seabrook, C.P. Johnson, D.S. Paulson, C.M. Beausoleil. Comparative of a new and innovative 2gluconate-impregnated...
  • [5] D. Eiselt. Presurgical skin preparation with a novel 2cloth reduces rates of surgical site infection in orthopaedic surgical patients....
  • [6] M.G. Zywiel, J.A. Daley, R.E. Delanois, Q. Naziri, A.J. Johnson, M.A. Mont. Advance pre-operative chlorhexidine reduces the incidence...
  • [7] A.J. Johnson, J.A. Daley, M.G. Zywiel, R.E. Delanois, M.A. Mont. Preoperative chlorhexidine preparation and the incidence of surgical...
  • [8] E.J. Lowbury, H.A. Lilly. Use of 4 per cent chlorhexidine detergent solution (hibiscrub) and other methods of skin disinfection. Br Med...
  • [9] A.F. Kaul, J.F. Jewett. Agents and techniques for disinfection of the skin. Surg Gynecol Obstet, 152 (1981), pp. 677-685
  • [10] Wilson ML, Mitchell M, Morris AJ, Murray PR, Reimer LG, Reller LB, et al. Principles and procedures for blood cultures; approved guideline....
  • [11] W.H. Self, J. Mickanin, C.G. Grijalva, F.H. Grant, M.C. Henderson, G. Corley, et al. Reducing blood culture contamination in community...
  • [12] S.C. Bleasdale, W.E. Trick, I.M. Gonzalez, R.D. Lyles, M.K. Hayden, R.A. Weinstein. Effectiveness of chlorhexidine bathing to reduce...
  • [13] Severity scoring of atopic dermatitis: The Scorad index. Consensus report of the European task force on atopic dermatitis. Dermatology,...
  • [14] M.W. Climo, D.S. Yokoe, D.K. Warren, T.M. Perl, M. Bolon, L.A. Herwaldt, et al. Effect of daily chlorhexidine bathing on hospital-acquired...
  • [15] M.W. Climo, K.A. Sepkowitz, G. Zuccotti, V.J. Fraser, D.K. Warren, T.M. Perl, et al. The effect of daily bathing with chlorhexidine on...
  • [16] H.L. Evans, T.H. Dellit, J. Chan, A.B. Nathens, R.V. Maier, J. Cuschieri. Effect of chlorhexidine whole-body bathing on hospital-acquired...
  • [17] S.Z. Kassakian, L.A. Mermel, J.A. Jefferson, S.L. Parenteau, J.T. Machan. Impact of chlorhexidine bathing on hospital-acquired infections...
  • [18] K.J. Popovich, B. Hota, R. Hayes, R.A. Weinstein, M.K. Hayden. Effectiveness of routine patient cleansing with chlorhexidine gluconate...
  • [19] M.O. Vernon, M.K. Hayden, W.E. Trick, R.A. Hayes, D.W. Blom, R.A. Weinstein, Project Chicago Antimicrobial Resistance. Chlorhexidine...
  • [20] K.J. Popovich, B. Hota, R. Hayes, R.A. Weinstein, M.K. Hayden. Daily skin cleansing with chlorhexidine did not reduce the rate of central-line...
  • [21] M.J. Noto, H.J. Domenico, D.W. Byrne, T. Talbot, T.W. Rice, G.R. Bernard, et al. Chlorhexidine bathing and health care-associated infections:...
  • [22] E.J. Septimus, M.K. Hayden, K. Kleinman, T.R. Avery, J. Moody, R.A. Weinstein, et al. Does chlorhexidine bathing in adult intensive care...
  • [23] K.J. Popovich, R. Lyles, R. Hayes, B. Hota, W. Trick, R.A. Weinstein, et al. Relationship between chlorhexidine gluconate skin concentration...
  • [24] D. Caldeira, C. David, C. Sampaio. Skin antiseptics in venous puncture-site disinfection for prevention of blood culture contamination:...
  • [25] M. Maiwald, E.S. Chan. The forgotten role of alcohol: A systematic review and meta-analysis of the clinical efficacy and perceived role...